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Biomedical subjects

Diane Holditch-Davis

Publications and source records attributed to Diane Holditch-Davis.

At least 19 recordsLinked to original sources
PubMed2006

Effects of antenatal magnesium sulfate and corticosteroid therapy on sleep states of preterm infants.

This exploratory longitudinal study was designed to compare the neonatal illness severity, sleep-wake, and respiratory sleep behaviors of preterm infants whose mothers received prenatal corticosteroids and/or magnesium sulfate (MgSO4) with those of infants whose mothers did not receive these medications. The 134 infants were divided into four groups: those whose mothers received MgSO4 only, those who received steroids only, those who received both MgSO4 and steroids, and those who received neither. The groups did not differ on infant characteristics or illness severity. Infants exposed to MgSO4 had more active sleep without rapid eye movement, indicating poorly organized active sleep. The MgSO4 -only group had higher quiet sleep regularity scores and fewer state changes. These findings suggest that fetal exposure to MgSO4 may subtly affect the central nervous system.

Adrenal Cortex Hormones↗
PubMed2006

Risk and protection in the development of problem behaviors in adolescents.

The development of problem behaviors among adolescents is affected by complex interactions between risk and protective factors. This study was designed to determine whether selected risk and protective factors described among participants in the National Longitudinal Study of Adolescent Health predicted problem behavior cluster membership. Approximately, 13,000 adolescents from the Add Health study were examined. Three clusters of adolescents (exhibiting normal, problem, and deviant behaviors) and changes in cluster membership over 1 year were examined for relationships to specific risk and protective factors. Findings revealed that factors for current behavior problems differ from those for changes in cluster membership. These results suggest that approaches to preventing problems may differ from those required to help adolescents who are already manifesting problems.

Adolescent↗
PubMed2005

Cyclicity of neonatal sleep behaviors at 25 to 30 weeks' postconceptional age.

Previous sleep studies of preterm neonates describe the rudimentary expression of sleep state cyclicity after 30 wk postconceptional age (PCA), with stability over multiple cycles only after 36 wk PCA. The research objective for this study was to determine whether sleep state cyclicity was expressed in neonates of 25-30 wk PCA, using two criteria for state identification. Our neonatal sleep consortium includes a total cohort of 359 children who were healthy and medically ill neonates who were recruited from three obstetric-neonatal services and received multiple-hour EEG sleep studies. A subset of the 33 youngest preterm infants were selected to evaluate the first of serial 2- to 3-h EEG-sleep recordings to assess the presence of sleep state cyclicity. One neonatal neurophysiologist visually assigned EEG-sleep characteristics for each record. Rapid eye movement (REM) counts and EEG discontinuity were specifically chosen to assess whether sleep cyclicity was expressed. A combined measure of REM and EEG discontinuity were used in an autocovariance analysis to assess cycling and mean cycle duration. A mean cycle duration of 68 +/- 19 min with a range of 37-100 min was determined from the REM-EEG discontinuity state for 24 neonates. The remaining nine infants had absent or poor sleep cyclicity. Sleep state cyclicity is expressed for a majority of neonates between 25 and 30 wk PCA, reflecting an ultradian biologic rhythm during the early perinatal stage of brain development.

Activity Cycles↗
PubMed2005

Clusters of problem behaviors in adolescents.

This study was designed to examine clusters of problem behaviors in a sample from the National Longitudinal Study of Adolescent Health at two time points. The technique employed was a person-oriented approach, cluster analysis. Three clusters were identified, a normal behaviors cluster, a problem behaviors cluster, and a deviant behaviors cluster. The clusters were tested for stability and for their relationships to the demographic variables gender, race, age, and socioeconomic status. The mean values for most of the problem behaviors in the problem behaviors cluster were higher than for those in the normal behaviors cluster and lower than for those in the deviant behaviors cluster. Selling drugs and weapon use distinguished the deviant behaviors cluster from the other two. Different interventions probably will be required to address the needs of those in each of the different clusters.

Adolescent↗
PubMed2005

Symptom-focused management for African American women with Type 2 diabetes: a pilot study.

The purpose of this pilot study was to test the effectiveness of an in-home, nurse-delivered, symptom-focused teaching/counseling intervention with older rural African American women who have type 2 diabetes. Forty-one participants were randomly assigned to either the intervention or the comparison group. Participants in the intervention showed statistically significant improvement in their medication, diet, home glucose monitoring self-care practices, perceptions of quality of life, and distress from symptoms. Both groups evidenced improvement of HbA(1c) levels. The intervention group achieved greater improvement, but the difference was not statistically significant. Participant satisfaction was high. Further studies should look into the cost of the intervention, as compared with that of usual care, and its long-term effects.

Adult↗
PubMed2004

Sleeping and waking state development in preterm infants.

BACKGROUND: Most studies of sleep-wake states of preterm infants have been cross-sectional. Thus, the extent to which sleep-wake development occurs within individuals and how environmental factors affect the development of sleeping and waking is unclear. AIMS: This study examined the development of sleeping and waking during the preterm and early post-term periods and the effects of infant health and environmental characteristics. DESIGN: Longitudinal, descriptive design. PARTICIPANTS: 134 preterm infants at high risk for developmental problems because of birthweights under 1500 g or mechanical ventilation. OUTCOME MEASURES: Weekly 2-h behavioral observations were conducted from the time infants were no longer critically ill until 43 weeks post-conceptional age or discharge. A single follow-up observation was conducted 1-3 months later. RESULTS: Active sleep, large body movements and the percent of no REM during active sleep decreased with age, and quiet waking, active waking, quiet sleep and regularity of respiration in active sleep and quiet sleep increased. The state of sleep-wake transition increased until 40 weeks and then decreased after 43 weeks CA. Negative facial expressions showed a quadratic decrease over age. Active waking, active sleep, negative facial expressions and quiet sleep regularity showed a change of development after term. Infant characteristics, illness severity and medical treatments, the handling due to performing an EEG and hospital had only minor effects. CONCLUSIONS: Significant development of sleeping and waking occurs over the preterm period. Additional research is needed to determine how the change from the hospital to the home environment affects on these developmental trajectories.

Female↗
PubMed2004

Gender, ethnicity, and the interactions of prematurely born children and their mothers.

This study examined the relationship of child gender and maternal ethnicity to the interactive behaviors of 53 3-year-old prematurely born children and their mothers. Boys and Non-White children had more developmental sequelae. Although most interactive behaviors did not differ by gender or ethnicity, mothers expressed more positive affect to girls than boys, and girls looked at their mothers more often and expressed more positive affect. White mothers expressed more positive affect, touched more, and had better scores on three Home Observation for Measurement of the Environment (HOME) Inventory subscales and the total HOME score than Non-White mothers. Child behaviors did not differ by ethnicity. Gender and ethnic group differences were affected by maternal education and child illness severity. Thus, although the interactive behaviors of mothers and prematurely born children are related to both child gender and ethnicity, some of these effects are better explained by maternal education and child illness severity. The systems view of the mother-child relationship is used to interpret these findings.

Adult↗
PubMed2004

Respiratory development in preterm infants.

OBJECTIVE: This study examined the development of respiration during the preterm and early post-term periods and the effects of other biological and environmental variables, including sleep state, on this development. STUDY DESIGN: Weekly 2-hour sleep observations and respiration recordings were obtained on 134 preterm infants from the time they were no longer critical until hospital discharge; a follow-up observation was conducted 1 to 3 months later. RESULTS: All respiratory variables, except length of respiratory pauses in quiet sleep, decreased although the rate of this decrease slowed after term for four variables. Respiratory variables, except variability of respiratory pauses lengths and periodic respiration, differed by sleep state. Covariates, except methylxanthine treatment, had minor effects. Four variables showed hospital-related differences, but cisapride treatment helped to explain the differences in three variables. CONCLUSIONS: Much development of respiration occurs in the early weeks after birth and reflects both neural maturation and effects of other biological and environmental factors, especially medications.

Child Development↗
PubMed2004

Assaultive behavior in Alzheimer's disease: identifying immediate antecedents during bathing.

To identify immediate antecedents of bathing-related physical assaults against caregivers by nursing home residents with Alzheimer's disease and related disorders, videotapes of nursing home residents who physically assaulted nursing assistants during baths were analyzed. Caregiver behaviors that occurred significantly (p < .01) more often during the 5 seconds preceding an assault included: calling the resident by name, confrontational communication, invalidation of the resident's feelings, failure to prepare the resident for a task, disrespectful speech, any touch, absence of physical restraint, and hurried pace of bath. Assaults were significantly more likely when caregivers sprayed water without a verbal prompt; the resident's feet, axilla, or perineum were touched; residents exhibited signs of temperature discomfort; and multiple caregivers were present. Improved caregiver training and individualized, gentler bathing methods should be investigated as methods of reducing assaults.

Aged↗
PubMed2003

Mother-infant interactions of medically fragile infants and non-chronically ill premature infants.

At 6 months corrected for prematurity, 41 medically fragile prematures, 20 medically fragile full-terms, and 28 prematures without chronic illnesses were observed interacting with their mothers for 1 hr. Mothers of non-chronically ill prematures gestured to and touched their infants less, were uninvolved with them for a longer time, and spent less time interacting and looking at their infants than did mothers of medically fragile infants. Medically fragile full-terms slept more than the non-chronically ill prematures. The non-chronically ill premature group played with objects more and exhibited more locomotion. Thus, the non-chronically ill prematures had more mature behaviors but less frequent interactions than did the medically fragile infants. These disparities reflect differences both in the infants' functional maturity and in maternal compensation for infant vulnerability.

Adult↗
PubMed2003

Enhancing nursing research with children and families using a developmental science perspective.

Nursing scholarship on children and their families has increased rapidly over the past decades. This research focuses on infants, children, and adolescents and their families facing acute or chronic illness, as well as on promoting health and preventing disease in children. While the amount and scope of research in pediatric nursing has increased, the methods and theories used are diverse and are often not based on the most recent science in the broader fields of developmental research. Developmental science, which evolved over the past two decades into a new interdisciplinary framework for the study of human development, involves an integrated holistic, developmental, and systems-oriented perspective. According to this view, the individual functions and develops through dynamic and complex processes involving the integration of many systems within the individual, including mental, biological, and behavioral systems. In addition, individuals function and develop in a continuously ongoing, reciprocal process of interaction with their environment and, as such, have an influence on that environment. These nonlinear, dynamic processes demand complex conceptualizations and research designs if one is to truly understand human development, including health and illness. Key aspects of developmental science important in conceptualization, design, measurement, and data analysis are identified. By providing a framework for critiquing research and presenting recommendations for future research based on developmental science, we hope to move nursing research with children forward toward more developmentally sound knowledge of nursing practice.

Acute Disease↗
PubMed2003

Care of preterm infants: programs of research and their relationship to developmental science.

The purpose of this review was to examine the topics covered in current programs of nursing research on the care of the preterm infant and to determine the extent to which this research is informed by developmental science. A researcher was considered to have a current program of research if he or she had at least five publications published since 1990 and was the first author on at least three of them. The infants in a study could be any age from birth throughout childhood; studies focusing on parenting, nursing, or other populations of infants were not included. Seventeen nurse researchers had current programs of research in this area. These programs had four themes. Those of Becker, Evans, Pridham, Shiao, and Zahr focused on infant responses to the neonatal intensive care unit (NICU) environment and treatments. Franck, Johnston, and Stevens focused on pain management. Harrison, Ludington-Hoe, and White-Traut's research focused on infant stimulation. Holditch-Davis, McCain, McGrath, Medoff-Cooper, Schraeder, and Youngblut studied infant behavior and development. These research programs had many strengths, including strong interdisciplinary focus and clinical relevance. However, additional emphasis is needed on the care of the critically ill infant. Also, despite the fact that the preterm infant's neurological system develops rapidly over the first year, only three of these researchers used a developmental science perspective. Only research on infant behavior and development focused on the developmental changes that the infants were experiencing. Most of the studies were longitudinal, but many did not use statistics appropriate for identifying stability and change over time. The response of individual infants and the broader ecological context as evidenced by factors such as gender, ethnic group, culture, and intergenerational effects were rarely examined. Thus research on the care of preterm infants could be expanded if the developmental science perspective formed the basis of more studies.

Child Development↗
PubMed2002

Worry about child health in mothers of hospitalized medically fragile infants.

PURPOSE: This study examined child health worry among mothers of medically fragile infants with differing health problems and identified factors associated with maternal worry. SUBJECTS: Medically fragile infants were term (38%) and preterm (62%) infants who had a life-threatening health problem that necessitated a long hospitalization and dependence on technology for survival. The 78 mothers were recruited during their infants' hospitalization. Their mean age was 26 years. Most had a high school education, were married, and were from diverse ethnic/racial backgrounds. DESIGN: Descriptive correlational design using data from a larger longitudinal study. METHODS: Mothers completed questionnaires while the infants were hospitalized. OUTCOME MEASURES: Instruments measured worry about the child's health (Child Health Worry Scale), maternal characteristics (demographic questionnaire), satisfaction with family (Family APGAR scale), illness-related stress (Parental Stressor Scale: Infant Hospitalization), and illness-related factors (diagnostic category, age/days hospitalized, and technology dependence). RESULTS: The highest source of worry was medical problems, followed by worry about whether the child would be normal, when the child could come home, and whether the child would always be sick. There was no significant difference in level of worry among mothers of infants with chronic lung disease, congenital airway anomalies, severe gastrointestinal problems, complex congenital heart disease, neurologic diagnoses, and those grouped as other. Fewer days hospitalized, lower maternal education, and higher stress associated with the child's appearance and behavior were related to higher levels of maternal worry. CONCLUSIONS: Mothers of critically ill infants, regardless of the type of diagnosis, worry about aspects of their infant's health. Mothers, especially mothers with a low educational level, need support from nurses to understand and cope with their infant's illness to reduce distress associated with worry.

Adult↗
PubMed2002

Reciprocity and retaining African-American women with HIV in research.

Retaining African-American women who are human immunodeficiency virus (HIV) positive in longitudinal research is crucial to improving prevention and treatment in this population. Interviews with 22 African-American HIV-positive women conducted at the end of a 2-year study indicated that over the course of the study, reports of discomfort with participation gave way to reports of appreciating the benefits of participation. Women commented on the importance of their relationships with researchers, in which they received benefits and provided a service to the researchers. We postulate that developing reciprocity between research teams and participants may be helpful in retaining African-American women in research.

Adult↗
PubMed2002

Perceptions of stress, worry, and support in Black and White mothers of hospitalized, medically fragile infants.

The purpose of this article is to describe maternal perceptions about hospital-related stressors, worry about the infant's health, and support from the health care team in mothers of medically fragile infants. A second purpose was to explore possible differences between Black and White mothers on these same variables. Participants were 31 Black and 38 White mothers of infants who were hospitalized in a tertiary hospital for a serious life-threatening illness. Data were collected using five self-report questionnaires. All mothers reported high levels of stress associated with the appearance of their infants and moderately high stress associated with their altered parental role, moderately high levels of worry about their infants' health problems, and high support from nursing and the health care team. Black mothers were more stressed by the sights and sounds of the hospital environment; however, the levels of their stress were only moderate. On the other hand, mothers with less education expressed more worry about their infants than did mothers with more education. Findings have implications for helping mothers during the hospitalization of a critically ill infant.

Adult↗
PubMed2002

Preterm infants born at less than 31 weeks' gestation have improved growth in cycled light compared with continuous near darkness.

OBJECTIVES: Our purpose was to evaluate the benefits of cycled light (CL) versus near darkness (ND) on health in preterm infants born at <31 weeks' gestational age. STUDY DESIGN: Randomized, interventional study comparing infants receiving (1) CL from birth, (2) CL at 32 weeks' postconceptional age (PCA), and (3) CL at 36 weeks' PCA in transition for discharge home. Statistical significance was assessed with segmented mixed general linear models, analysis of covariance, general estimating equations, chi(2), and Fisher's exact procedure. RESULTS: Infants receiving CL at birth and 32 weeks' PCA gained weight faster than infants not receiving CL until 36 weeks' PCA. There were no differences among the groups in length of hospitalization stay or number of ventilator days, but the power was low for these variables. CONCLUSIONS: These findings suggest that CL has significant weight gain benefits over ND, and there are no short-term advantages of ND over cycled light for health in preterm infants.

Body Weight↗